Individual
RYAN FAIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1040 NW 22ND AVE STE 520, PORTLAND, OR 97210-3097
(503) 413-7557
Mailing address
PO BOX 3808, PORTLAND, OR 97208-3808
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
DO197810
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PENDING
—
OR
Enumeration date
07/30/2015
Last updated
07/08/2020
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